tbuckley/cabot-search huggingface dataset:
Emerging strategies to overcome resistance to third-generation EGFR inhibitors
Authors: Kunyu Shi, Guan Wang, Junping Pei, Jifa Zhang, Jiaxing Wang, Liang Ouyang, Yuxi Wang, Weimin Li
Journal: Journal of Hematology & Oncology (2022)

Abstract Epidermal growth factor receptor (EGFR), the receptor for members of the epidermal growth factor family, regulates cell proliferation and signal transduction; moreover, EGFR is related to the inhibition of tumor cell proliferation, angiogenesis, invasion, metastasis, and apoptosis. Therefore, EGFR has become an important target for the treatment of cancer, including non-small cell lung cancer, head and neck cancer, breast cancer, glioma, cervical cancer, and bladder cancer. First- to third-generation EGFR inhibitors have shown considerable efficacy and have significantly improved disease prognosis. However, most patients develop drug resistance after treatment. The challenge of overcoming intrinsic and acquired resistance in primary and recurrent cancer mediated by EGFR mutations is thus driving the search for alternative strategies in the design of new therapeutic agents. In view of resistance to third-generation inhibitors, understanding the intricate mechanisms of resistance will offer insight for the development of more advanced targeted therapies. In this review, we discuss the molecular mechanisms of resistance to third-generation EGFR inhibitors and review recent strategies for overcoming resistance, new challenges, and future development directions.
Acceptance of Simulated Adult Patients With Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis
Authors: Victoria A. Marks, Walter R. Hsiang, James Nie, Patrick Demkowicz, Waez Umer, Afash Haleem, Bayan Galal, Irene Pak, Dana Kim, Michelle C. Salazar, Elizabeth R. Berger, Daniel J. Boffa, Michael S. Leapman
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Although there have been significant increases in the number of US residents insured through Medicaid, the ability of patients with Medicaid to access cancer care services is less well known. <h3>Objective</h3> To assess facility-level acceptance of Medicaid insurance among patients diagnosed with common cancers. <h3>Design, Setting, and Participants</h3> This national cross-sectional secret shopper study was conducted in 2020 in a random sample of Commission on Cancer–accredited facilities in the United States using a simulated cohort of Medicaid-insured adult patients with colorectal, breast, kidney, and melanoma skin cancer. <h3>Exposures</h3> Telephone call requesting an appointment for a patient with Medicaid with a new cancer diagnosis. <h3>Main Outcomes and Measures</h3> Acceptance of Medicaid insurance for cancer care. Descriptive statistics, χ<sup>2</sup>tests, and multivariable logistic regression models were used to examine factors associated with Medicaid acceptance for colorectal, breast, kidney, and skin cancer. High access hospitals were defined as those offering care across all 4 cancer types surveyed. Explanatory measures included facility-level factors from the 2016 American Hospital Association Annual Survey and Centers for Medicare &amp; Medicaid Services General Information database. <h3>Results</h3> A nationally representative sample of 334 facilities was created, of which 226 (67.7%) provided high access to patients with Medicaid seeking cancer care. Medicaid acceptance differed by cancer site, with 319 facilities (95.5%) accepting Medicaid insurance for breast cancer care; 302 (90.4%), colorectal; 290 (86.8%), kidney; and 266 (79.6%), skin. Comprehensive community cancer programs (OR, 0.4; 95% CI, 0.2-0.7;<i>P</i> = .007) were significantly less likely to provide high access to care for patients with Medicaid. Facilities with nongovernment, nonprofit (vs for-profit: OR, 3.5; 95% CI, 1.1-10.8;<i>P</i> = .03) and government (vs for-profit: OR, 6.6; 95% CI, 1.6-27.2;<i>P</i> = .01) ownership, integrated salary models (OR, 2.6; 95% CI, 1.5-4.5;<i>P</i> = .001), and average (vs above-average: OR, 6.4; 95% CI, 1.4-29.6;<i>P</i> = .02) or below-average (vs above-average: OR, 8.4; 95% CI, 1.5-47.5;<i>P</i> = .02) effectiveness of care were associated with high access to Medicaid. State Medicaid expansion status was not significantly associated with high access. <h3>Conclusions and Relevance</h3> This study identified access disparities for patients with Medicaid insurance at centers designated for high-quality care. These findings highlight gaps in cancer care for the expanding population of patients receiving Medicaid.
Undergraduate degrees will no longer count towards specialty training applications
Authors: Joy Hodkinson, Marina Politis
Journal: BMJ (2022)

<h3>BACKGROUND</h3> Little is known of the optimal dose and administration schedule of hydrocortisone in critically ill patients with congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency. <h3>AIM</h3> To determine plasma cortisol concentrations after intravenous administration of hydrocortisone in children with CAH and to relate these to plasma cortisol concentrations achieved by endogenous secretion in the stress of critical illness in previously healthy children. <h3>METHODS</h3> Plasma cortisol concentrations were measured in 20 patients with classical CAH (median age 11.2 years, range 6.1–16.4) following intravenous administration of hydrocortisone 15 mg/m<sup>2</sup>; and in 60 critically ill mechanically ventilated children (median age 2.5 years, range 0.25–16.3) on admission to the paediatric intensive care unit and for 24 hours thereafter. <h3>RESULTS</h3> In the CAH patients, plasma cortisol reached a mean peak of 1648.3 nmol/l (SD 511.9) within 10 minutes of the intravenous bolus, and fell rapidly thereafter; levels remained greater than 450 nmol/l for 2.5 hours only. In critically ill children, mean plasma cortisol on admission to the intensive care unit was 727 nmol/l (SD 426.1). Cortisol concentrations remained raised during the first 24 hours. <h3>CONCLUSIONS</h3> Critically ill patients with classical CAH may be best managed with a single intravenous hydrocortisone bolus followed by a constant rate infusion of hydrocortisone.
Early Recurrence Detection of Glioma Using 18F-Fluorocholine PET/CT
Authors: Ana María García Vicente, Mariano Amo-Salas, Hernán Sandoval Valencia, Elena Lozano Setien, Ángel María Soriano Castrejón
Journal: Clinical Nuclear Medicine (2022)

The aim of this study was to analyze the usefulness of 18 F-fluorocholine PET/CT in the early diagnosis of tumor recurrence, increasing the diagnosis confidence of MRI.Patients with a previous gross total resection of glioma and the first suspicious or doubtful for recurrence MRI were prospectively included and subjected to 18 F-fluorocholine PET/CT. An independent and combined assessment of 18 F-fluorocholine PET/CT and multimodal MRI was performed classifying the studies as positive or negative for tumor recurrence. Final diagnosis (recurrence or not) was obtained by histological confirmation or clinical and imaging follow-up. The relation of SUV max and tumor-to-background ratio with progression, the diagnostic performance of imaging techniques, and their concordance (κ Cohen) were analyzed.Twenty-four studies on 21 patients were assessed. Recurrence was diagnosed in 20 cases. PET/CT was positive in 23 cases (3 false positive), whereas MRI was positive in 15 cases (1 false positive). MRI was false negative in 6 cases. There was no false negative on 18 F-fluorocholine PET/CT. Accuracy of PET/CT versus MRI was 87.5% and 70.8%, respectively. The combined evaluation of both techniques did not show any advantage with respect to PET/CT results alone. The concordance between both imaging techniques was low (κ = 0.135; P = 0.375). SUV max and tumor-to-background ratio were related to recurrence (areas under the curve of 0.844 [ P = 0.033] and 0.869 [ P = 0.022], respectively).18 F-fluorocholine PET/CT was helpful for increasing the diagnostic confidence in the cases of MRI doubtful for recurrence in order to avoid a delayed diagnosis.
The role of confocal endomicroscopy for diagnosis of solid pseudopapillary tumor of the pancreas
Authors: Ahamed A. Khalyfa, Umesh Kapur, Kamran Ayub
Journal: Endoscopy (2022)

The patient is a 31-year-old woman with a past medical history of asthma who presented with a 2-month history of left flank pain that radiated to the back. Initial labs including hepatic and biliary profile were unremarkable. Computed tomography (CT) of the abdomen and pelvis was significant for a 12.5-cm well-circumscribed mass with internal septations in the pancreatic tail with an anterior enhancing solid component. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed followed by confocal laser endomicroscopy ([Fig. 1 a, b]), which revealed small- to medium-sized dark clusters of cells consistent with tumor cells ([Video 1]).
Diagnosis of Traumatic Bronchobiliary Fistula With Late 99mTc-Mebrofenin SPECT/CT
Authors: Yazmín Sánchez-Vera, Estrella Aguilera-Hernández, David R. Cardoza-Ochoa, Jorge Iván González-Díaz
Journal: Clinical Nuclear Medicine (2022)

Abstract Bronchobiliary fistula (BBF) represents a rare disorder; it consists of abnormal interconnection between the biliary tract and bronchial trees. A 22-year-old woman with persistent chest pain, jaundice, and biliptysis was referred for hepatobiliary scintigraphy under clinical suspicion of a BBF. Patient medical history was consistent with biliary tree reconstruction secondary to an iatrogenic injury during cholecystectomy 4 years ago. Previous complementary studies (CT and MR cholangiopancreatography) were equivocal for diagnosis. Planar dynamic images of hepatobiliary scintigraphy in the first hour were inconclusive. A 24-hour SPECT/CT was performed and confirmed the BBF in a minimally invasive way.
Treatment of a spontaneous intramural esophageal abscess by endoscopic mucosal incision: an easy and effective therapy
Authors: Jiyu Zhang, Huige Wang, Dan Liu
Journal: Endoscopy (2022)

A previously healthy 34-year-old man presented with severe chest pain, with cough and dyspnea lasting for 2 days. The chest pain had begun after a dinner and the consumption of alcohol, but he denied the ingestion of any foreign body. On physical examination, no palpable mass was observed on the neck, and his lungs were clear on auscultation. His laboratory results at presentation showed significant increases of white blood cells (23.02 × 109 /L), with 90 % neutrophils, and C-reactive protein level (180 mg/L). Other tests including serology for cytomegalovirus (CMV) and tuberculosis were within normal limits. A contrast-enhanced computed tomography (CT) scan revealed wall thickening and a low density accumulation in the upper and middle esophagus ([Fig. 1]). Endoscopic examination revealed a longitudinal bulge at 20–30 cm distal to the incisors ([Fig. 2]). The patient was prescribed ciprofloxacin 400 mg intravenously; however, he complained of a fever and chills 2 days later. A three-dimensional reconstruction technique was used to facilitate diagnosis and characterize the esophageal lesion ([Fig. 3]). Notably, repeat endoscopy showed pus flowing from a fistula at the upper part of the bulge, consistent with a diagnosis of esophageal abscess ([Fig. 4a]).
Magnetic compression anastomosis using a double-balloon enteroscope for complete obstruction of Roux-en-Y hepaticojejunostomy anastomosis
Authors: Dilara Turan Gökçe, Bülent Ödemiş, Çağdaş Erdoğan
Journal: Endoscopy (2022)

Standard treatment for most post-cholecystectomy bile duct injuries is Roux-en-Y hepaticojejunostomy [1]. Conventional treatment of complete anastomotic obstruction after this procedure is revision surgery, which has high morbidity and mortality. Therefore, less invasive treatments are preferred, such as guidewire tapping, needle knife puncture, and magnetic compression anastomosis [2] [3].
Direct retroperitoneal necrosectomy through an insufficient jejunal blind stump after gastrectomy for necrotizing pancreatitis
Authors: Antonia Gantschnigg, Franz Singhartinger, Iris Mühlbacher, Oliver Koch, Klaus Emmanuel, Josef Holzinger
Journal: Endoscopy (2022)

A 53-year-old patient with a history of alcohol abuse presented with acute severe epigastric pain. Computed tomography (CT) showed signs of acute pancreatitis with a 9-cm measuring walled-off pancreatic necrosis (WOPN) in the pancreatic tail, with broad-based contact to the greater curvature of the stomach. Initial gastroscopy revealed severe ischemic gastric wall necrosis without signs of perforation ([Fig. 1]). An electrocautery-enhanced lumen-apposing metal stent (LAMS; 15 × 10 mm) was implanted transgastrically under endoscopic ultrasound guidance, to enable direct necrosectomy ([Fig. 2]). Because of a suspicion of splenic infarction, another CT scan was performed; this showed free air collections in the upper abdomen, with urgent suspicion of gastric wall perforation in the area of the ischemic gastric wall. A gastrectomy was done, with reconstruction by esophagojejunostomy and Roux-en-Y anastomosis.
Solitary Central Nervous System Relapse of Posttransplant Lymphoproliferative Disorder on 18F-FDG PET/CT
Authors: Lijuan Feng, Xu Yang, Xia Lu, Wei Wang, Jigang Yang
Journal: Clinical Nuclear Medicine (2022)

A 41-year-old woman received stem cell transplant due to acute myeloid leukemia. Six months after the stem cell transplant, the patient experienced monomorphic PTLD (posttransplant lymphoproliferative disorder) and underwent chemotherapy. Postchemotherapy PET/CT did not show any abnormal 18 F-FDG accumulation in the scanned body, including brain. Four months later, she presented with nausea and vomiting. Brain MRI showed a lesion in the right temporal lobe. In addition to the abnormal 18 F-FDG accumulation in the brain, no other abnormal foci were noted in the torso PET/CT. Biopsy pathology confirmed the diagnosis of monomorphic PTLD.
Left Forearm Langerhans Cell Sarcoma Demonstrated by 18F-FDG PET/CT
Authors: Limeng He, Yujiao Deng, Jing Huang, Hongjun Xie, Wei Zhang
Journal: Clinical Nuclear Medicine (2022)

Abstract Langerhans cell sarcoma is a rare neoplastic proliferation of Langerhans cells with a poor prognosis. We report FDG PET/CT findings of Langerhans cell sarcoma in the left forearm of a 77-year-old woman who presented with progressive enlargement of the left forearm mass for over 2 months. 18 F-FDG PET/CT demonstrated a high FDG uptake by the mass along with several FDG-avid enlarged lymph nodes in the left arm and axilla. Pathology examination of the biopsied specimen from the left forearm mass led to a diagnosis of Langerhans cell sarcoma.
Associations between moderate alcohol consumption, brain iron, and cognition in UK Biobank participants: Observational and mendelian randomization analyses
Authors: Anya Topiwala, Chaoyue Wang, Klaus P. Ebmeier, Stephen Burgess, Steven Bell, Daniel F. Levey, Hang Zhou, Celeste McCracken, Adriana Roca-Fernández, Steffen E. Petersen, Betty Raman, Masud Husain, Joel Gelernter, Karla L. Miller, Stephen M. Smith, Thomas E. Nichols
Journal: PLoS Medicine (2022)

Brain iron deposition has been linked to several neurodegenerative conditions and reported in alcohol dependence. Whether iron accumulation occurs in moderate drinkers is unknown. Our objectives were to investigate evidence in support of causal relationships between alcohol consumption and brain iron levels and to examine whether higher brain iron represents a potential pathway to alcohol-related cognitive deficits.
Ovalbumin and Poly(i:c) Encapsulated Dendritic Cell‐Targeted Nanoparticles for Immune Activation in the Small Intestinal Lymphatic System
Authors: Kyoung Sub Kim, Sanghee Lee, Kun Na, You Han Bae
Journal: Advanced Healthcare Materials (2022)

Abstract Here, antigen and adjuvant encapsulated dendritic cell‐targeted nanoparticles for immune activation in the small intestinal lymphatic system to inhibit melanoma development are described. This strategy is demonstrated using chondroitin sulfate‐coated nanoparticles (OPGMN) grafted with glycocholic acid and mannose for cationic liposomes encapsulated with ovalbumin as an antigen and polyinosine‐polycytidylic acid as a cancer‐specific adjuvant. OPGMN is absorbed in the gastrointestinal tract and delivered to the lymph nodes when orally administered. Oral delivery of OPGMN induces increased dendritic cell maturation compared to the intradermal route in the lymph node and induces T helper type 1 and type 2 responses, such as immunoglobulin G1 and G2c, interferon‐gamma, and interleukin‐2, in the blood. Repeated oral administration of OPGMN increases the population of CD3 + CD8 + T cells, CD44 high CD62L low memory T cells, and CD11b + CD27 + natural killer cells in the blood. OPGMN completely prevents melanoma development in the B16F10‐bearing C57BL/6 mouse model by reducing the population of CD4 + CD25 + Foxp3 + regulatory T cells in the blood. This strategy is expected to prevent the recurrence of tumors after various cancer treatments.
Endoscopic ultrasound-guided hepaticojejunostomy using forward-viewing echoendoscope for transected aberrant right posterior hepatic duct in Roux-en-Y hepaticojejunostomy
Authors: Kazuya Koizumi, Sakue Masuda, Kento Shionoya, Makomo Makazu
Journal: Endoscopy (2022)

An aberrant right posterior hepatic duct is one of the most common risk factors for bile duct injury during surgical procedures. Complete transection of the bile duct necessitates surgical repair. Recently, endoscopic ultrasound (EUS)-guided hepaticojejunostomy using a forward-viewing echoendoscope to manage complete biliary obstruction in patients with surgically altered anatomy has been reported [1] [2] [3] [4]. Although most of the reports described complete stenosis of hepaticojejunostomy anastomoses with pancreaticoduodenectomy and modified Child reconstruction, none has documented repairing a completely transected bile duct with Roux-en-Y hepaticojejunostomy.
Incidental Findings of Coexisting Metastatic Pancreatic Cancer in Patients With Prostate Cancer on 18F–Prostate-Specific Membrane Antigen PET/CT
Authors: Yang Lu, Chun Li
Journal: Clinical Nuclear Medicine (2022)

A 79-year-old man with rising prostate-specific antigen of 3.2 ng/mL and diagnosis of metastatic castration-resistant prostate cancer received abiraterone and prednisone for treatment regarding prostate-specific membrane antigen (PSMA)-avid bone lesions on PET/CT. Four months later, a follow-up 18 F-DCFPyL PET/CT demonstrated new and increased multifocal PSMA-avid osseous and liver lesions, whereas prostate-specific antigen was stabled at 3.1 ng/mL. Biopsy of liver lesion showed metastasis from a primary pancreatic acinar cell carcinoma. Retrospectively, PSMA-avid pancreatic body lesion was identified on both PSMA PET/CT scans. This case illustrated that any above background PSMA uptake in the pancreas warrants suspicion for malignancy.
Complete resection of a giant tumor in the ultralow rectum by a combination of transanal local excision and endoscopic submucosal dissection
Authors: Tingfa Peng, Liansong Ye, Jianchuan Chen, Huiping Li, Rongmei Gao, Bing Hu
Journal: Endoscopy (2022)

Local recurrence is the main problem after ultralow rectal surgery [1]. Transanal local excision provides an adequate visual field at the anus and allows for good hemostasis of hemorrhoidal veins, but may leave residual lesions and cause perforation for lesions with severe fibrosis [2] [3]. Endoscopic submucosal dissection is difficult for ultralow rectal lesions owing to the poor visual field at the dentate line and frequent bleeding from the hemorrhoidal veins, but residual lesions and perforation can be avoided by setting accurate resection lines [4]. Herein, we present a hybrid technique combining transanal local excision and endoscopic submucosal dissection for a giant tumor in the ultralow rectum, with the technique helping to achieve complete resection, prevent perforation, and preserve anal function.
AL-Type Amyloidosis Involving Stomach and Lungs in 99mTc-DPD Bone Scan
Authors: Yeongjoo Lee, Ie Ryung Yoo, Joo Hyun O
Journal: Clinical Nuclear Medicine (2022)

Abstract Systemic AL (amyloid light-chain) amyloidosis is a relatively rare disease. 99m Tc-DPD (3,3-diphosphono-1,2-pyrophosphate) bone scan is a highly sensitive diagnostic tool for cardiac amyloidosis of ATTR (transthyretin) type. In AL amyloidosis, there have been some previous reports of extracardiac DPD uptake in liver, kidney, and spleen, but not in stomach. We present 99m Tc-DPD bone scan images of AL-type amyloidosis involving stomach and lung.
99mTc-Sestamibi Thyroid Scintigraphy in Amiodarone-Induced Thyrotoxicosis
Authors: Ray Wang, Nathan Better, Dinesh Sivaratnam, James Westcott, Simon Forehan, Michael Christie, David A. Pattison, Spiros Fourlanos
Journal: Clinical Nuclear Medicine (2022)

99m Tc-sestamibi thyroid scintigraphy (STS) can aid in differentiating between types 1 and 2 amiodarone-induced thyrotoxicosis (AIT). We present a consecutive case series of 4 men (aged 56-75 years) in whom both 99m Tc-STS and thyroid histology were consistent with a diagnosis of type 2 AIT, representing the first reported histopathologic correlation for this diagnostic test. Median amiodarone treatment duration was 26 months (range, 10-39 months), and amiodarone was discontinued a median of 3 months preoperatively (range, 2-4 months) in all 4 cases. 99m Tc-STS is a promising functional imaging modality, which has the potential to aid clinicians in the diagnostic workup and treatment of AIT.
Esophageal stent removal by stent cutting using the endoscopic submucosal dissection technique
Authors: Chikamasa Ichita, Akiko Sasaki, Jun Kawachi, Chihiro Sumida, Takashi Nishino, Sakue Masuda, Kazuya Koizumi
Journal: Endoscopy (2022)

The European Society of Gastrointestinal Endoscopy recommends temporary esophageal stenting for the treatment of benign esophageal leaks, but there is no consensus on the duration of stent placement [1]. Prolonged stenting can result in tissue hyperplasia that makes removal difficult, and forcible removal can cause esophageal perforation requiring surgery [2]. There are reports that a stent-in-stent approach enables stent removal [3], but it involves the cost of another stent. Argon plasma coagulation (APC) and an endoscopic submucosal dissection (ESD) knife are used to resect hyperplasia and reportedly allow stent removal [4] [5]. We unsuccessfully attempted to cut a stent using APC and completed the procedure by switching to an ESD knife. There are no reports of cutting gastrointestinal stents with an ESD knife and we report the procedure herein ([Video 1]).
Two-devices-in-one-channel method for preventing the preceding stent migration in case of multiple indwelling biliary inside plastic stents
Authors: Tesshin Ban, Yoshimasa Kubota, Takuya Takahama, Shun Sasoh, Tomoaki Ando, Makoto Nakamura, Takashi Joh
Journal: Endoscopy (2022)

Endoscopic bilateral biliary plastic stent placement is considered a viable option for drainage in patients with an unresectable malignant hilar obstruction [1]. Recently, a dedicated inside plastic stent with removal of threads emerged for malignant hilar obstruction, with a longer patency period and easier removal [2] [3]. However, the multiple inside plastic stent method harbors the risk of preceding stent migration owing to shear stress caused by the succeeding stents [4]. This article describes tips for preventing preceding stent migration using micro-alligator forceps through the two-devices-in-one-channel method [5].